How women cope with a false positive breast cancer diagnosis

A new study set out to determine how women cope with a false positive-diagnosis of breast cancer

Robin Wulffson, MD

Many women undergo mammograms periodically to screen for breast cancer. Not uncommonly, a false-positive result will occur. Later tests will determine that a cancer is not present; however, until that occurs, a woman must cope with the possibility of having a serious—and sometimes fatal—medical condition. A new study set out to determine how women cope with a false positive-diagnosis of breast cancer. The findings were published on April 21 in the journal JAMA Internal Medicine.

The study authors note that the potential harm from a false-positive mammogram is currently being evaluated by the US Preventive Services Task Force. Thus, they conducted a study to determine the effect of false-positive mammograms on quality of life by measuring personal anxiety, health utility, and attitudes toward future screening.

A telephone survey, named the Digital Mammographic Imaging Screening Trial (DMIST) quality-of-life was conducted shortly after the participants underwent a screening mammogram and one year later at 22 DMIST sites; women were randomly selected from the DMIST participants; the study group included women with both positive and negative mammograms. Among 1,450 eligible women who were invited to participate, 1,226 (84.6%) were enrolled; follow-up interviews were obtained from 1,028 (83.8%).

To evaluate the impact of the diagnosis, the investigators used a six question short form of the Spielberger State-Trait Anxiety Inventory state scale (STAI-6) and the EuroQol EQ-5D instrument with US scoring. Attitudes toward future screening were measured by the women’s self-report of future intention to undergo mammographic screening; in addition, they were asked about their willingness to travel and stay overnight to undergo a theoretical new type of mammography, which would identify as many cancers with half the false-positive results.

Not surprisingly, anxiety was significantly higher for women with false-positive mammograms (STAI-6: 35.2 vs. 32.7); however, health utility scores did not differ and there were no significant differences between the two groups at one year. Future screening intentions differed between the two groups (false-positive: 25.7%; negative: 14.2%); willingness to travel and stay overnight did not differ between the groups (false-positive: 9.9%; negative: 10.5%). Future intention to undergo screening was significantly increased among women with false-positive mammograms (2.12-fold increased intention to be screened), younger women (2.78-fold increased intention), and poorer health (1.63-foldincreased intention). Women who suffered from a high degree of anxiety regarding future false-positive mammograms were much more likely to travel overnight (1.94-fold increased intention).

The authors concluded that false-positive mammograms were associated with increased short-term anxiety but not long-term anxiety. Furthermore, they found no measurable health utility decrement. False-positive mammograms increased women’s intention to undergo future breast cancer screening; however, it did not increase their stated willingness to travel to avoid a false-positive result. The investigators noted that their finding of time-limited harm after a false-positive screening mammograms is relevant for healthcare professionals who counsel women on mammographic screening and for screening guideline development groups.

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Robin Wulffson is a California native and a graduate of the UCLA School of Medicine. He is a Diplomate of the American Board of Obstetrics and Gynecology and a Lifetime Fellow of the American Board of Obstetrics and Gynecology. He served as a battalion surgeon with the 2/77th Artillery, 25th Infantry Division in Vietnam; he was awarded a Bronze Star and a Purple Heart. Following his specialty training, he practiced obstetrics and gynecology in Orange County, California for 25 years. In addition to his medical and military background, he has a keen interest in technology, including automobiles. Since 1998, he has done freelance writing in the healthcare field. He has published two novels, which feature a strong female protagonist: An Improbable Cause and Avalon. Dr. Wulffson resides with his family in Tustin, California.